Healthcare Provider Details

I. General information

NPI: 1861599334
Provider Name (Legal Business Name): LAURA STOCKDALE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA STOCKDALE

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 WESTFIELD DR
KNOXVILLE TN
37919-4824
US

IV. Provider business mailing address

6231 HIGHLAND PLACE WAY STE 101
KNOXVILLE TN
37919-4083
US

V. Phone/Fax

Practice location:
  • Phone: 865-264-2400
  • Fax:
Mailing address:
  • Phone: 865-264-2400
  • Fax: 865-588-6406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP0000001492
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: